Background: Although health information technology (HIT) can facilitate communication of test result data, 7% of electronically transmitted abnormal laboratory test results are nevertheless lost to follow-up. One potential method to mitigate delays in follow-up is to increase patients' access to their test results. Stage 2 meaningful use criteria incentivize patient engagement and highlight the importance of providing patients with electronic access to their clinical information. Although some test results are now available to patients through secure portals, the use of these tools remains low overall, and the utility of patient notification via portals for abnormal test results is especially unclear. More empirical knowledge is needed about how HIT could play a role in improving abnormal test result communication and follow-up, and what features HIT-based tools should possess. Knowledge of patients' needs and preferences for results notification via portals is essential to optimizing design and implementation of notification systems. Objectives: The goal of this application is to explore and improve how HIT can be leveraged to help patients manage follow-up of abnormal test results. These goals are highly significant because failures to follow-up abnormal test results lead to delays in diagnosis and treatment and may result in patient harm. To develop patient-centered practices and design for test result management via portals, we will address many socio- technical variables that influence outcomes in this area, including technological (e.g., software, clinical content and user interface design) as well as non-technological factors (e.g., inter-personal communication, clinical workflows, processes, and procedures). Aims and Methods: Our application is guided by a conceptual model that posits a set of eight socio-technical dimensions that should be considered in HIT interventions such as test results delivery via patient portals. Aim 1 will elicit patients' needs, preferences and responses when receiving abnormal test results via patient portals. We will conduct interviews to identify individual scenarios and test result notification preferences via portals, observe portal use for these test results notification scenarios, and conduct focus groups to explore socio- technical factors that affect the use of test result notification. In Aim 2, we will develop functional requirements and socio-technical solutions to address patients' needs, preferences and responses to receiving abnormal test results via patient portals. We will develop scenarios of complex or challenging situations of receiving and responding to abnormal test result notifications and using these scenarios, we will conduct a staged world Cognitive Task Analysis study. The proposed work will leverage our multidisciplinary team's experience with innovative approaches to understanding and improving HIT and electronic communication in outpatient settings. Findings will identify functional requirements for patient portals and facilitate patients' involvement in management of appropriate test result follow-up.